Provider Demographics
NPI:1740220524
Name:GENESIS HEALTH DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:GENESIS HEALTH DEVELOPMENT, INC.
Other - Org Name:BROOKS REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-345-7473
Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-345-7291
Mailing Address - Fax:904-345-7284
Practice Address - Street 1:8505 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4225
Practice Address - Country:US
Practice Address - Phone:904-419-6101
Practice Address - Fax:904-345-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8869570-Medicaid
FL106542Medicare Oscar/Certification
FL8869570-Medicaid